Figure 1323

Mean percentage changes in bone mineral density of the lumbar spine after transplantation. Substantial bone loss can occur quite early after transplantation. Metabolic bone disease in this setting is usually multifactorial. Most often, patients who had end-stage renal disease before transplantation already have some degree of renal osteodystrophy, exacerbated in some cases by the impact of aluminum toxicity or ^-microglobulin amyloidosis. Patients with diabetes are particularly at risk for low-turnover bone disease. Administration of corticosteroids and cyclosporine also contributes to bone loss. Although biochemical evidence of secondary hyperparathyroidism usually resolves during the first year after transplantation, some patients may have persistent parathyroid-driven bone resorption, with or without hypercalcemia, and may require surgical parathyroidectomy. Asterisk— values significantly different from those at the time of transplantation. (From Julian and coworkers [38]; with permission.)

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